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DocuSign Envelope ID: 87A62A7A-FC32-4CDC-B206-9FB91AB3C6B6 <br />CNA Business Auto Policy <br />Policy Endorsement <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />This endorsement modifies insurance provided under the following: <br />AUTO DEALERS COVERAGE FORM <br />BUSINESS AUTO COVERAGE FORM <br />MOTOR CARRIER COVERAGE FORM <br />With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless <br />modified by this endorsement. <br />This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability <br />Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter <br />coverage provided in the Coverage Form. <br />This endorsement changes the policy effective on the inception date of the policy unless another date is <br />indicated below. <br />I Named lnsurnd, OAC SERVICES, INC. <br />SCHEDULE Name Of Person(s) Or Organization{s): <br />ANY PERSON OR ORGANIZATION THAT THE NAMED INSURED IS OBLIGATED TO PROVIDE INSURANCE <br />WHERE REQUIRED BY A WRITTEN CONTRACT OR AGREEMENT IS AN INSURED, BUT ONLY WITH RESPECT <br />TO LEGAL RESPONSIBILITY FOR ACTS OR OMISSIONS OF A PERSON/ORGANIZATION FOR WHOM <br />LIABILITY COVERAGE IS AFFORDED UNDER THIS POLICY. <br />Information required to complete this Schedule, if not shown above, will be shown in the Declarations. <br />Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but <br />only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision <br />contained in Paragraph A.1. of Section II -Covered Autos Liability Coverage in the Business Auto and Motor <br />Carrier Coverage Forms and Paragraph D.2. of Section I -Covered Autos Coverages of the Auto Dealers <br />Coverage Form. <br />Form No: CA 20 48 10 13 <br />Endorsement Effective Date: Endorsement Expiration Date: <br />Endorsement No: 4; Page: 1 of 1 <br />Underwriting Company: Valley Forge Insurance Company, 151 N Franklin St, Chicago, IL 60606 <br />"'Copyright Insurance Services Office, Inc., 201 1 <br />Policy No: BUA 6080369580 <br />Policy Page: 36 of 53